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Available from: Richard Lessells, Aug 25, 2015
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    • "Methods Hlabisa HIV Treatment and Care Programme and Africa Centre Demographic Information System (ACDIS) The Hlabisa HIV Treatment & Care Programme (HHTCP) delivers comprehensive HIV treatment and care in Hlabisa health subdistrict, northern KwaZulu-Natal (Mutevedzi et al. 2010; Houlihan et al. 2011 "
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    ABSTRACT: Objective To determine rates of, and factors associated with, disengagement from care in a decentralised antiretroviral programme. Methods Adults (16years) who initiated antiretroviral therapy (ART) in the Hlabisa HIV Treatment and Care Programme August 2004-March 2011 were included. Disengagement from care was defined as no clinic visit for 180days, after adjustment for mortality. Cumulative incidence functions for disengagement from care, stratified by year of ART initiation, were obtained; competing-risks regression was used to explore factors associated with disengagement from care. ResultsA total of 4,674 individuals (median age 34years, 29% male) contributed 13610 person-years of follow-up. After adjustment for mortality, incidence of disengagement from care was 3.4 per 100 person-years (95% confidence interval (CI) 3.1-3.8). Estimated retention at 5years was 61%. The risk of disengagement from care increased with each calendar year of ART initiation (P for trend <0.001). There was a strong association between disengagement from care and higher baseline CD4+ cell count (subhazard ratio (SHR) 1.94 (P<0.001) and 2.35 (P<0.001) for CD4+ cell count 150-200 cells/l and >200 cells/l respectively, compared with CD4 count <50 cells/l). Of those disengaged from care with known outcomes, the majority (206/303, 68.0%) remained resident within the local community. Conclusions Increasing disengagement from care threatens to limit the population impact of expanded antiretroviral coverage. The influence of both individual and programmatic factors suggests that alternative service delivery strategies will be required to achieve high rates of long-term retention.
    Tropical Medicine & International Health 06/2013; 18(8). DOI:10.1111/tmi.12135 · 2.30 Impact Factor
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    • "older people. The Hlabisa HIV treatment and care programme, as in the rest of South Africa, is mostly nurse and counsellor led and follows the South African Department of Health (DoH) guidelines (Houlihan et al., 2011). Older people who are HIV-infected usually receive psycho-social counseling before, during and after HIV testing. "
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    ABSTRACT: BACKGROUND: Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions. OBJECTIVES: Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people. METHODS: In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). RESULTS: Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions. LIMITATIONS: Study limitations include the cross-sectional design, limited sample size and possible selection biases. CONCLUSIONS: Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.
    Journal of Affective Disorders 05/2013; 151(1). DOI:10.1016/j.jad.2013.05.005 · 3.71 Impact Factor
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    • "The DSA is located in the catchment area of a decentralised, public-sector ART programme launched in August 2004 (Houlihan et al. 2010). By the end of 2010, ART coverage in the DSA had risen to about 75% under CD4 count eligibility threshold of CD4 < 200 ⁄ ll stipulated by the South African national treatment guidelines at the time (Malaza et al. 2011). "
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    ABSTRACT: While self-assessments of health (SAH) are widely employed in epidemiological studies, most of the evidence on the power of SAH to predict future mortality originates in the developed world. With the HIV pandemic affecting largely prime age individuals, the strong association between SAH and mortality derived from previous work might not be relevant for the younger at-risk groups in countries with high HIV prevalence in the era of antiretroviral treatment. We investigate the power of SAH to predict mortality in a community with high HIV prevalence and antiretroviral treatment (ART) coverage using linked data from three sources: a longitudinal demographic surveillance, one of Africa's largest, longitudinal, population-based HIV surveillances, and a decentralised rural HIV treatment and care programme. We used a Cox proportional hazards specification to examine whether SAH significantly predicts mortality hazard in a sample composed of 9217 adults aged 15-54, who were followed up for mortality for 8 years. Self-assessments of health strongly predicted mortality (within 4 years of follow-up), with a clear gradient of the adjusted hazard ratios (aHRs), relative to the baseline of 'excellent' self-assessed health status and controlling for age, gender, marital status, the socio-economic status (SES), variables education, employment, household expenditures and household assets, and HIV status and ART uptake: 1.40 (95% CI 0.99-1.96) for 'very good' self-assessed health status (SAHS); 2.10 (95% CI 1.52-2.90) for 'good' SAHS; 3.12 (95% CI 2.18-4.45) for 'fair' SAHS; and 4.64 (95% CI 2.93-7.35) for 'poor' SAHS. While a similar association remained in the unadjusted analysis of long-term mortality (within 4-8 years of follow-up) the hazard ratios capturing SAH are jointly insignificant in predicting of mortality once HIV status, ART uptake and gender, age, marital status and SES were controlled for. HIV status and ART programme participation were large and highly significant predictors of long-term mortality. Our findings validate SAH as a variable that significantly predicts short-term mortality in a community in sub-Saharan Africa with high HIV prevalence, morbidity and mortality. When predicting long-term mortality, however, it is much more important to know a person's HIV status and ART programme participation than SAH.
    Tropical Medicine & International Health 07/2012; 17(7):844-53. DOI:10.1111/j.1365-3156.2012.03012.x · 2.30 Impact Factor
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